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Cardiovascular risk and the possibility of its correction in women with premature ovarian insufficiency

https://doi.org/10.17749/2313-7347.2018.12.4.037-046

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Abstract

Since recently, the association of premature ovarian insufficiency (POI) with an increased risk of mortality and morbidity caused by cardiovascular diseases (CVD) has been extensively discussed in the context of early detection and prevention of CVD in these patients. Aim: to evaluate the relative cardiovascular risk (CV risk) before and after hormone replacement therapy (HRT) in women with POI. Materials and methods. The study included 170 women aged from 18 to 40; among them, 85 women with POI and 85 women with regular periods. We evaluated the usual CV risk factors: smoking habits, arterial blood pressure, total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins; in addition, we determined apolipoprotein B (Apo B), high-sensitivity C-reactive protein (hs-CRP), uric acid, and endotelin-1, as well as the functional markers: the right and left carotid intima-media thickness (CIMT) and the brachial artery flow-mediated dilatation (FMD). The CV risk was calculated using the relative risk SCORE scale before and after HRT lasted for 12 months. Results. In the POI group, there were 3.8 times more women with a moderate CV risk (per the SCORE scale), whereas in the POI-free group, women with a low CV risk dominated. In addition, the levels of CV risk markers were 4-fold higher in patients with POI (high levels of Apo B, hs-CRP and uric acid, increased CIMT bilaterally, decreased FMD in the brachial artery). Cyclic HRT during 12 months contributed to the lipid profile normalization, decrease in TC, LDL and FMD in the brachial artery as well as to the decrease of relative CV risk in general. Conclusion. The estrogen deficiency in patients with POI is an independent factor in the increased relative risk of CVD. The HRT has anti-atherogenic, antiinflammatory, and angioprotective effects, regulates the production of endothelium-dependent factors of vasoconstriction and vasodilation, leading to a reduction in the relative risk of CVD in general.

About the Authors

A. A. Pozdnyakova
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov
Russian Federation

Postgraduate Student, Department of Gynecological Endocrinology

4 Academician Oparin St., Moscow 117997, Russia

+7(916)2764029



L. A. Marchenko
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov
Russian Federation

MD, PhD, Professor, Leading Researcher, Department of Gynecological Endocrinology

4 Academician Oparin St., Moscow 117997, Russia

+7(495)5314444



N. K. Runikhina
Russian Gerontology Clinical Research Center, N.I. Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Deputy Director

16 First Leonov St., Moscow 129226, Russia

+7(916)1199377



References

1. Roeters van Lennep J.E., Heida K.Y., Bots M.L., Hoek A. Сardiovascular disease risk in women with premature ovarian insufficiency: А systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23(2):178–86.

2. Tao X.Y., Zuo A.Z., Wang J.Q., Tao F.B. Effect of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis. Climacteric. 2016;19(1):27–36.

3. Muka T., Oliver-Williams C., Kunutsor S. et al. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: a systematic review and meta-analysis. JAMA Cardiol. 2016;1(7):767–76. DOI: 10.1001/jamacardio.2016.2415.

4. Boytsov S.A., Pogosova N.V., Bubnova M.G. et al. Cardiovascular prophylaxis 2017. Russian national guidelines. [Kardiovaskulyarnaya profilaktika 2017. Rossijskie nacional'nye rekomendacii]. Rossijskij kardiologicheskij zhurnal. 2018; 23 (6): 7–122 (in Russ.).

5. Webber L., Davies M., Anderson R. et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31(5):926–37.

6. Chazova I.E., Ratova L.G., Boytsov S.A. et al. Diagnosis and treatment of arterial hypertension (Recommendations of Russian Medical Society of Arterial Hypertension and the All-Russian Scientific Society of Cardiology). [Diagnostika i lechenie arterial'noj gipertenzii (Rekomendacii rossijskogo medicinskogo obshchestva po arterial'noj gipertonii i vserossijskogo nauchnogo obshchestva kardiologov)]. Sistemnye gipertenzii. 2010;(3):5–26 (in Russ.).

7. Catapano A.L., Graham I., De Backer G. et al. 2016 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37(39):2999–3058. DOI: 10.1093/eurheartj/ehw272.

8. Gordon T., Kannel W.B., Hjortland M.C. et al. Menopause and coronary heart disease. The Framingham Study. Ann Intern Med. 1978;89:157–61.

9. Burgos N., Cintron D., Latortue-Albino P. et al. Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review. Endocrine. 2017;58(3):413–25.

10. The 2017 Hormone therapy position statement of the North American Menopause Society. Menopause. 2017;24(7):728–53.

11. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 698: hormone therapy in primary ovarian insufficiency. Obstet Gynecol. 2017;129(5):e134–e141.

12. Vujovic S., Brincat M., Erel T. et al. European Menopause and Andropause Society position statement: Managing women with premature ovarian failure. Maturitas. 2010;67(1):91–3.

13. Sukhikh G.T., Smetnik V.P., Yureneva S.V. et al. Menopause and menopausal status in women. Clinical guidelines. [Menopauza i klimaktericheskoe sostoyanie u zhenshchiny. Klinicheskie rekomendacii.]. Moskva, 2016. 45 p (in Russ.). Available at: http://naonob.ru/media/2018/07/07/1241338634/Menopauza_i_klimaktericheskoe_sostoyanie_u_zhenshhiny.pdf. [Accessed: 23.11.2018].

14. Christ J.P., Gunning M.N., Palla G. et al. Estrogen deprivation and cardiovascular disease risk in primary ovarian insufficiency. Fertil Steril. 2018;109(4):594–600.

15. Langrish J.P., Mills N.L., Bath L.E. et al. Cardiovascular effects of physiological and standard sex steroid replacement regimens in premature ovarian failure. Hypertension. 2009;53:805–11.

16. Collins P., Webb C.M., de Villiers T.J. et al. Cardiovascular risk assessment in women – an update. Climacteric. 2016;19:329–36.

17. Hamoda H. British Menopause Society and Women’s Health Concern. The British Menopause Society and Women's Health Concern recommendations on the management of women with premature ovarian insufficiency. Post Reprod Health. 2017;23(1):22–35. DOI: 10.1177/2053369117699358.


For citation:


Pozdnyakova A.A., Marchenko L.A., Runikhina N.K. Cardiovascular risk and the possibility of its correction in women with premature ovarian insufficiency. Obstetrics, Gynecology and Reproduction. 2018;12(4):37-46. (In Russ.) https://doi.org/10.17749/2313-7347.2018.12.4.037-046

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)